WARTS - Get ready to learn more than you probably ever wanted to know about warts. This
page discusses warts in general and the Long-Slow-Painless method of getting rid of them.
I also have some great pictures of a surgical excision of a wart belonging to Kristi.
To see Kristi's surgical wart removal please go to -->
This is a photograph of the bottom of Anna's foot. Anna is a most delightful 12 year
old girl who has noticed these things develop on the bottom of her foot for the last 6
months. She is an avid basketball player and they are starting to hurt.
Anna has one wart in the middle of her foot (on the left side of the picture) and a
cluster of a dozen more down by her heel. All, especially the one in the middle, cause a
hot, burning pain when she walks, runs and plays basketball.
Warts are caused by an infectious virus. The little virus gets into the skin through a
cut so small you do not know it is there. The virus particle gets into the deepest
layer of the dermis and takes up residence in the local cells. It works like all virus
particles by getting into the cell and tricking the cell into manufacturing hundreds or
thousands of additional virus particles. The cell ruptures spewing the virus particles
into the neighboring cells. These cells pick up the wart and repeat the cycle. Soon you
have so many cells with virus particles that the clump is visible as a wart.
Q. Why is this wart called a plantar wart?
A. Because the bottom of the foot is known as the plantar surface and a wart there is
thereby called a plantar wart. A callus there is called a plantar callus. (A fascia there
is called a plantar fascia.)
Q, What is a "Kissing Wart"?
A. Warts can spread directly from one part of the skin to anther if they rub
together. For example a wart on the big toe can spread to the 2nd toe just by
touching it. You end up with warts on each toe that are kind of mirror images of
each other. I have called them kissing warts for obvious reasons. This is an
example of a pair of kissing warts.
Double
click to enlarge pictures.
Direct transmission is one reason why I suggest that you not pick at your
warts with your fingers. Warts can spread to your finger and from you finger to
where ever you put it.
Q. How do warts spread
A. As Anna walks around she is leaving little piles of wart virus particles. She or her
neighbors or family members can step on these evil little particles and spread a wart. If
Anna insists on walking around the gym locker room barefooted with her warts, I have asked
her to always carry a supply of my business cards with her. She is sure to spread them. I
suspect that the wart up by Anna's toes came from this indirect method.
Another way they spread is from cell to cell. In cellular terms it is called
pinocytosis (now how often do I get to use that term?) The virus is thought to move from
cell to cell for three diameters of the wart. All of the warts clustered by Anna's heel
are spread this way.
Q. What do you call a wart that is distressed that you are going to get rid of it?
A. A worry wart! (Sorry)
Q. Why treat a wart?
A. warts are treated for three reasons: 1) they can hurt (just ask Anna) 2) they can
spread (again, ask Anna) and 3) if they stay in the skin long enough they can hurt
the deep layer of the skin causing a permanent scar.
Q. So what, you may ask, do I care about a scar on the bottom of my foot since no one
will see it..
A. Because walking on a scar can hurt every bit as much as the wart itself.
Q. What happens if you do not treat a wart?
A. One of three things may happen: It could stay the same for years, it could get
larger or spread to other parts of your (or other's) feet or it could go away. Left alone
many warts will go away by themselves given enough time. This may be a long time. however,
and, like Anna, you may not want to wait.
Q. How do you treat warts.
A. There are many ways to treat a wart. There is an old saying in medicine; If there
are many ways to treat something then none of them must be any good (or, implied, then if
one were really good, there would be only one way). I divide my favorite ways of wart
treatment into 1) Cut It Out Now 2)
The Long Slow Way and 3) Bleomyicn
injections (see
)
Cut It Out Now
To see great pictures of this method go to -->
This method Involves a nerve block with local anesthesia and using gentle instruments
to pry the little sucker right out of the foot. This leaves a little hole where each wart
used to be that extends down to (but not through) the bottom layer of the skin. This hole
(or these little holes) fill in with new epithelial cells over the next week or two and
all is well again. There is only a little pain with the anesthetic block (and I use the
Five Famous Tricks to make it hurt as little as humanly possible) and no pain with the
procedure itself. Anna wanted this method because she is sick and tired of her warts. I
persuaded her (and her delightful mom) that this would leave just too many little holes in
her foot and would get in the way of her basketball for several weeks. The advantage of
this method is that afterwards it is possible for Anna to leave the office with no warts
in her foot at all. About 15% of the time one or more of the little guys come back
requiring more treatment. The disadvantage is the pain (though minimal in experienced ad
gentle, gentle, gentle hands) and the need to put some kind of medicine on the little
holes for a week or so.
This is the celebration for the elimination of
the warts.
The Long Slow Way This
is the method I recommended for Anna. It is the gentle method that allows the warts to be
treated until they are gone with absolutely no pain at all. Involved are the following
1) Daily or nightly the part of the foot containing the warts is soaked in HOT
WATER for 15 minutes. The water needs to be between 105-109 degrees Fahrenheit.
Warts have developed in us as human hosts for thousands of years. They like 98.6 degrees.
If you heat them up a little they will die. Sometimes. But often enough that it is worth a
try. This is an old Farmer's Almanac remedy.
2) Apply a drop of over-the-counter wart acid to each and every. Let
it dry. Apply a second drop to each wart. As far as I am concerned all of these acid
containing products are roughly equivalent. If you come to my office I will write you a
prescription for one in the off chance that your insurance will help you pay for it.
3) Take a high dose of Vitamin A for a month or two. Now this is not a
super huge dose. Many drug store vitamins have 10,000 units in a pill form. I suggest you
take 20,000 units a day for two months. I have heard from the grape vine that that typical
Vitamin A is in the pro-vitamin A form, the gel capsule. You body converts only as much of
this product to the Vitamin A it thinks it needs, which is very little. You need actual
Vitamin A which is not readily available. A good source of this Vitamin A is mixed with a
little Zinc and is from Amway (this is not a solicitation - I am not an Amway
distributor).
4) Weekly debridement. Debridement is medical speak for trimming or
scraping the lesion) This means you need to visit your podiatrist every week and have him
or her scrape a the wart with a scalpel blade until he or she sees very tiny little spots
of pinpoint bleeding. Pinpoint bleeding is the end point of debridement.
Follow this plan and you will see the wart's get smaller and thinner weekly until they
are gone. This may take from four weeks to a lot longer.
These are pictures of Anna's warts after just one week of the long slow
method. For Anna it was not long and slow it was Very Fast. I have never seen a
wart resolve this fast before in my 15 years of practice. Do not expect to be
this lucky. I just wanted to show you that it is possible.
The picture on the left shows the foot just a week after surgery. The one in
the middle is a close up of the lesions that are resolving. Notice how black
some of them look. The black is perfect! It means the lesions are dying. The
black results from the death of the little blood vessels that feed the wart. The
right picture shows a close up of the very same black lesions after I cleaned
them out a little. Note that these little suckers are gone.
Q. What about freezing with liquid nitrogen?
A. Freezing the warts with liquid nitrogen is the mainstay of treatment by family
practitioners and some dermatologist. It is fabulous for warts on thin skin like the top
of the foot, the body surface and even the top of the hands. Unfortunately the skin on the
bottom of the foot is so thick that it is difficult to get sufficient freezing of the wart
without painful damage to the surrounding skin. While most podiatrists feel this method is
not very helpful for plantar warts we do see, after all, only those where the freezing
failed. If it did work, then these patients would never have a need for our office.
A Patient Asks
About Cimetidine (Tagamet)
Q. I have had
some warts surgically removed from my feet and now I have to go back to have
them removed again. One of the warts by the time I went in had
approximately doubled the size of my pinky toe. It was an extremely
painful healing process. That particular wart is the one that is back,
and it is accompanied by three on my hands and two more (much smaller ones) on
my feet. My doctor suggested taking 400mg of Tagamet (yes, the stomach
medicine) three times a day for one month. He said sometimes people have
found the medicine sensitizes your body to virus and causes the body to fight
it more effectively. I am concerned with taking medicine because my
husband and I would like to have children in the next year, but I saw your web site
and thought I would ask if you had heard of that or your thoughts on that.
Your web site is AWESOME by the way! I appreciate your time and
knowledge.
Sincerely,
Carri
Dear Carri,
Sorry I did
not mention Cimetidine (Tagamet). There have bee many, some
OK, two reports that Cimetidine is OK maybe
useful in treating warts in children but not in adults. Why the discrepancy?
The answer seems related to dose. You take so many milligrams of the
medication for each pound of body weight until you reach the total maximum
amount of medication you should take in a day. This seems to max out at about
110 pounds. If you weight less than this you can take "enough" of
the medicine to maybe make a difference. If you weight more than 110 pounds
then you cannot take a high enough of a dose to make a difference. This is
quite "iffy" so good luck.
Another testimonial
about Tagamet
Q. What is I have more questions?
A. Ask me with an e-mail and I will post them to this site.
